Evaluating Traditional Chinese Medicine Interventions in Polycystic Ovary Syndrome (PCOS)

Kit Li

Polycystic ovary syndrome (PCOS) (1) is a complex condition that affects both reproductive and metabolic health in women. Its exact cause is not fully understood, but it is widely recognised as a multifactorial disorder.

Diagnosis is usually based on a combination of:

• Irregular or absent ovulation
• Elevated androgen (male hormone) levels
• Polycystic ovarian appearance on ultrasound

Cases with higher androgen levels tend to be more severe. The condition can vary across different ethnic groups, is often more difficult to diagnose during adolescence and around menopause, and is commonly worsened by obesity. (2)

How do PCOS affect the ovulation?

In PCOS, ovulation does not occur regularly, which leads to low progesterone levels.  Under normal circumstances, after an egg is released, the follicle transforms into the corpus luteum. This structure produces progesterone during the second half of the menstrual cycle (the luteal phase).

However, in PCOS, hormonal imbalances, including elevated androgens, disruption of the LH/FSH ratio, and often insulin resistance, prevent follicles from fully maturing and ovulating.

As a result:

• Ovulation may be delayed or may not occur
• The corpus luteum does not form
• The body does not enter the progesterone-producing phase

This is why progesterone levels remain consistently low in many women with PCOS.

How do TCM approach in PCOS (3)?

From TCM perspective, PCOS is not described in terms of hormones. Instead, it is understood as a pattern of internal imbalance affecting the body’s systems.  What biomedicine describes as 'low progesterone' is seen in TCM as a failure to properly support the second half of the menstrual cycle, due to underlying organ disharmony.

The common patterns include:

Kidney deficiency: weak reproductive foundation (root imbalance)

In TCM, the Kidneys govern reproduction, growth, and transformation. When Kidney function is weak, the body lacks the necessary energy to support ovulation and the transition into the luteal phase.

Spleen deficiency with Dampness/Phlegm: obstruction (impaired ovulation)

A weakened Spleen can lead to the accumulation of Dampness and Phlegm. This creates internal obstruction, which can interfere with the proper development and release of follicles, reflecting anovulation.

Liver-Qi stagnation: irregular cycle regulation (cycle disruption)

Liver-Qi stagnation disrupts the smooth flow of Qi and blood, affecting cycle timing, ovulation, and overall regularity.

Is it difficult to conceive with PCOS?

It can be more challenging for women with PCOS to conceive, but it depends on the individual.

The main difficulty lies in irregular or delayed ovulation.  In a typical menstrual cycle, ovulation occurs around the middle of the cycle (often around day 14 in a 28-day cycle, though this varies). In women with PCOS, ovulation may be delayed or may not occur regularly at all.

Because ovulation is unpredictable:

• The fertile window is harder to identify
• Conception may take longer

However, many women with PCOS do successfully conceive. With appropriate support, including lifestyle changes, cycle tracking, and medical or holistic approaches, fertility outcomes can improve significantly.

Case Sharing

Miss A, a 30 year-old female, has been experiencing PCOS for several years. She has been using a mobile application to track her ovulation in order to improve her chances of conception. However, due to delayed ovulation (occurring around day 31 of her menstrual cycle), she has found it difficult to become pregnant. This ongoing challenge has also led to feelings of frustration.

Her initial treatment

She reported severe cramping over the past four days during her menstrual period, accompanied by heavy bleeding with  blood clots. She also described persistent fatigue and had recently developed symptoms of a cold with clear phlegm. Emotionally, she has been feeling low and increasingly distressed due to her ongoing health concerns and difficulty conceiving.

Tongue: Swollen body with central dry cracks, red 'strawberry-like' spots near the tip

Pulse: Guan position wiry on the left, Chi  and Guan position are thready on the right

Treatment Principle: 

• Soothe Liver-Qi, regulate the menstruation and calm her Shen
• Invigorate Blood and remove stasis
• Tonify Spleen-Qi and also nourish Kidney-Yin

Acupoints:

Scalp acupuncture: Central Area, Foot Motor Sensory Area, Spirit-Emotions Area, Reproduction Area

Body acupoints:

REN-12 (Renzhong) with Dao-Qi technique: Harmonises the Stomach and strengthens the Spleen, supports transformation and transportation (helps fatigue, dampness).

LU-7 (Liequ): Releases the exterior and strengthens Wei Qi, regulates Lung Qi and fluid pathways.

ST36 (Zusanli): a key point to strengthen the immune system, tonify the Spleen and Stomach, and support overall vitality.

SP-10(Xuehai): Invigorates Blood and dispels Blood stasis, important for menstrual disorders (clots, pain).

SP-6 (Sanyinjiao): Tonifies Spleen, Liver, and Kidney, regulates menstruation and benefits the uterus.

KI-3 (Taixi): Nourishes Kidney Yin and strengthens Kidney function, benefits reproductive system and fertility.

LV-3 (Taichong): Spreads and soothes Liver Qi, helps relieve pain due to Qi stagnation.

Prescription: 

• Yu Ping Feng San modification （玉屏风散) (4) is considered the best immune tonic herb in stabilizing and strengthening the protective 'Qi', it is also for invigorating Qi and boost up her immunity.  There are 8 ingredients in the modification formula and the core ingredients are HuangQi (Astragalus Root) (5), Baizhu (Atractylodes Rhizome) and Fangfeng (Siler Root /            Saposhnikovia Root).

• Liu Wei Di Huang Wan (六味地黄丸) (6)  is commonly used for Kidney-yin deficiency, irregular menstruation, and infertility (including PCOS patterns).  The ingredients are Shu Di Huang (Rehmannia Root, prepared), Shan Zhu Yu (Cornelian Cherry Fruit), Shan Yao (Chinese Yam), Ze Xie (Water Plantain Rhizome),  Mu Dan Pi (Moutan Cortex / Tree Peony Bark), Fu Ling (Poria / Hoelen).

Feedbacks: Cold symptoms resolved, with the patient reporting increased calmness and improved sleep quality.

Conclusion: Following this intervention, six sessions of scalp acupuncture were provided alongside modified herbal  prescriptions. Progesterone levels increased significantly, from 8.7 to 23.1. Ovulation also occurred earlier, shifting from day 31 to day 25, suggesting improved cycle regulation. Treatment will continue on a weekly basis to maintain these outcomes.

As a final note, it is always advisable to consult with a qualified TCM practitioner who can tailor herbal remedies and acupuncture treatments to your specific needs, as individual constitutions vary.

References:

1) Polycystic Ovary Syndrome: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/

2) Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome: https://pubmed.ncbi.nlm.nih.gov/26426951/

3) Combined TCM therapies improve ovulation: https://pubmed.ncbi.nlm.nih.gov/38996123/

4) Yu Ping Feng San: https://pmc.ncbi.nlm.nih.gov/articles/PMC3823765/

5) Research state of the herbal medicine Huangqi (Radix Astragali): A global and bibliometric study: https://pubmed.ncbi.nlm.nih.gov/38394541/

6) Liuwei Dihuang Pills alleviate the polycystic ovary syndrome with improved insulin sensitivity through PI3K/Akt signaling pathway: https://chatgpt.com/c/69d4fa06-47d4-832d-b966-e74ddda42fa9